Pentobarbital (Nembutal)

Category:

• Sedatives

Description:

• Hypnotic/sedative, anticonvulsant

Indications:

• Insomnia (short-term) status epilepticus

• Facilitation of intubation and anesthesia

Contraindications:

• Respiratory depression

• Severe liver impairment, porphyria

Precautions:

• Pregnancy category D

• Myasthenia gravis, myxedema, anemia, hepatic disease, renal disease

• Hypertension, elderly, acute or chronic pain, mental depression

• History of drug abuse, abrupt discontinuation, children

• Hyperthyroidism, fever, diabetes

Adverse Reactions (Side Effects):

• CNS: CNS depression, drowsiness, hangover, headache, lethargy, slurred speech, stimulation in elderly and children, physical dependence, mental depression

• CV: bradycardia, hypotension

• GI: constipation, diarrhea, nausea, vomiting

• HEME: agranulocytosis, megaloblastic anemia, thrombocytopenia

• RESP: apnea, bronchospasm, depression, laryngospasm

• SKIN: abscess at injection site, angioedema, erythema multiforme, Stevens-Johnson syndrome, thromboplebitis, urticaria

• MISC: rickets, osteomalacia

Dosage:

Administered orally, rectally, intramuscularly, intravenously

• Adult:            

  • Hypnotic: 

    • PO 100-200mg at bedtime or 20mg 3-4 times daily for daytime sedation; IM 150-200mg

    • IV 100mg initially, may repeat every 1-3 minutes up to 200-500mg total

    • PR 120-200mg at bedtime

  • Preoperative sedation: 

    • IM 150-200mg

  • Pentobarbital coma for increased intracranial pressure: 

    • IV 10-15 mg/kg over 1-2 hours loading dose, then 1 mg/kg/hour 

    • INF, increase to 2-3 mg/kg/hour if necessary; maintain burst suppression on EEG

• Child:            

  • Sedative: 

    • PO 2-6 mg/kg/day divided 3 times daily; max 100mg daily

  • Hypnotic: 

    • IM 2-6 mg/kg; max 100 mg/dose; PR <4years 3-6 mg/kg/dose, >4 years 1.5-3 mg/kg/dose

  • Preoperative sedation: 

    • PO/IM/PR 2-6 mg/kg; max 100 mg/dose

    • IV 1-3 mg/kg to max of 100mg until asleep

  • Pentobarbital coma for increased intracranial pressure: 

    • Same as adult